Plaintiffs’ Cross-Motion for Summary Judgment against UnitedHealthcare For Failing to Cover Lactation Services Granted In Part

Condry et al. v. UnitedHealth Group Inc. et al.

In November 2017, UnitedHealthcare (“UHC”) moved for summary judgment as to the Named Plaintiffs.  UHC’s primary theories related to the scope of comprehensive lactation support and counseling (“CLS”), and what types of providers in its network can render CLS services. UHC argued that the Named Plaintiffs received in network CLS and/or had in-network CLS providers available to them, but chose to go out-of-network.  In response, Plaintiffs opposed and also moved for cross-motion for summary judgment based on findings that:

(a) UHC’s coverage for CLS violated the ACA;

(b) UHC did not establish a provider network that included trained providers of CLS;

(c) UHC did not provide access to in-network trained providers of CLS;

(d) UHC was not permitted under the ACA to deny, or apply cost-sharing to, claims submitted for CLS; and

(e) UHC did not timely and/or properly process the Plaintiffs’ claims for CLS.

On June 27, 2018, U.S. District Judge Vince Chhabria for the Northern District of California, issued a ruling on the motions for summary judgment filed by both Plaintiffs and Defendants – granting in part and denying in part the motions (which are outlined below).  Plaintiffs are pleased with the ruling as, among other things, the Court’s Order held that, contrary to UHC’s argument, not every member of its health plans had meaningful access to in-network lactation services, and further stated that “a woman does not have access to lactation support if she cannot practically find those services.”  See, Order at page 2.  The Court also took issue with UHC’s “attempt to draw a line between” (i) preventive lactation services, and (ii) diagnostic lactation services.  Judge Chhabria said, UHC’s “limited view of the [ACA’s] coverage provisions would mean that mothers would stop receiving free lactation support and counseling exactly at the moment that they started experiencing the kinds of difficulties that lead mothers to stop breastfeeding.” See, Order at page 3.

Motions for Summary Judgment
Count Claim Alleged by Summary Judgment Ruling
Count I Claims Processing Condry, Hoy, Endicott, Bishop, and Barber Granted to Plaintiffs
Count II Coverage of Lactation Services as required by ERISA Condry, Hoy, Endicott, Bishop, and Barber Granted to Plaintiffs as to Hoy and Bishop

Granted to Defendants as to Condry and Barber

Denied to both sides as to Endicott

Count III Joint Liability Condry, Hoy, Endicott, Bishop, and Barber Denied to both sides
Count IV Sex Discrimination All Plaintiffs Granted to Defendants
Count V Coverage of Lactation Services as required by the ACA Carroll Denied to both sides
Count VI Unjust Enrichment Carroll Granted to Defendants